Metastasis of esophageal carcinoma to the brain

BACKGROUND: Esophageal carcinoma rarely metastasizes to the brain. The objectives of the current study were to assess the frequency of brain metastasis from an esophageal primary tumor, to determine correlates of survival, and to describe treatment modalities and their outcomes. METHODS: Between June, 1993 and July, 2001, 1588 patients with a primary esophageal carcinoma registered at The University of Texas M. D. Anderson Cancer Center; of those, 27 patients (1.7%) had a diagnosis of brain metastasis. The authors collected demographic and clinical data and performed a statistical analysis. RESULTS: The median age at the time patients were diagnosed with brain metastasis was 62 years. Tumor histologies were adenocarcinoma in 22 patients (82%), unclassified carcinoma in 3 patients (11%), and squamous cell carcinoma in 2 patients (7%). Twenty patients (74%) experienced symptoms related to the brain metastasis. The metastases were treated with whole-brain radiation therapy (WBRT) alone in 15 patients (56%), and 10 patients (37%) underwent surgical resection, 4 of whom (15%) also received WBRT. Two patients (7%) underwent stereotactic radiosurgery. The median survival for the entire cohort after diagnosis of the primary tumor was 12.6 months (95% confidence interval [CI], 2.17-22.5 months), and the median survival after the diagnosis of brain metastasis was 3.8 months (95% CI, 1.1-6.5 months). The longest median survival observed after the diagnosis of brain metastasis (9.6 months) occurred in patients with a single brain lesion who underwent resection and received WBRT. There was a trend toward worse survival in patients with liver metastases and patients in recursive partitioning analysis (RPA) Class II-III versus RPA Class I (P = 0.10 for both; multivariate Cox proportional hazards model analysis). CONCLUSIONS: Approximately 2% of patients with esophageal carcinoma had a diagnosis of brain metastasis. Improved outcome was associated with single brain lesions in patients who underwent surgery and received WBRT. Known liver metastasis and higher RPA scores were associated with a poorer survival trend.     

Brain metastasis from prostate carcinoma: The M. D. Anderson Cancer Center experience

BACKGROUND: The objective of this study was to estimate the incidence and describe distribution, clinical presentation, and prognosis of brain metastases in patients with prostate carcinoma who were seen at The University of Texas M. D. Anderson Cancer Center (MDACC). METHODS: The authors reviewed the charts of 16,280 patients with prostate carcinoma in the MDACC patient data base. Of 131 patients with craniospinal metastases confirmed by neuroimaging (n=53 patients) or autopsy (n=78 patients), 103 of 16,280 patients (0.63%) had parenchymal metastases. RESULTS: The median patient age at diagnosis was 64 years (range, 16-85 years). The median interval from the diagnosis of prostate carcinoma to the detection of brain metastasis was 35 months for patients with adenocarcinoma and 48 months for patients with small cell carcinoma (SCC). Confusion, headache, and memory deficits were the most frequent initial symptoms. Eighty-six percent of patients had single lesions, and 14% of patients had > or = 2 lesions. Metastases were supratentorial in 81 of 103 patients (76%), infratentorial in 22 of 103 patients (21%), and both supratentorial and infratentorial in 3 of 103 patients (3%). SCC and cribriform subtypes were more likely than adenocarcinoma to metastasize to the brain (relative risk, 20.36; 95% confidence interval, 9.91-41.84). Regardless of histology, the median survival in untreated patients was 1 month compared with 3.5 months in patients who were treated with radiotherapy. Patients who underwent stereotactic radiosurgery (n=5 patients) had a longer median survival (9 months). Survival was not affected by supratentorial or infratentorial location of metastases. CONCLUSIONS: Brain metastasis from prostate carcinoma is a rare, terminal event with death in <1 year frequently due to advanced, systemic disease. The majority of metastases were single and supratentorial. The most common clinical presentation was nonfocal neurologic symptoms related to intracranial hypertension. A better understanding of the biology of prostate carcinoma will help clarify the basis for its metastasis to the brain.     

228例肺癌脑转移患者的临床观察#br#

目的探讨肺癌脑转移患者的临床及影像学特征。 方法回顾性分析2014年1月至2016年12月江苏省肿瘤医院放疗科诊治的228例肺癌脑转移患者的临床资料。 结果228例患者中男性140例,女性88例,中位年龄60岁,腺癌171例,小细胞癌35例,鳞癌22例。有脑转移症状者93例,无症状者135例。中位脑转移瘤确诊时间为5个月,890％患者在2年内确诊脑转移。1年内有、无颅外转移患者的中位脑转移瘤确诊时间分别为30个月和60个月,差异有统计学意义（P＜005）。脑实质转移227例,单纯幕上转移149例,单纯幕下转移15例,幕上、幕下均有转移63例。累及幕上者以顶叶（528％）和额叶（448％）最常见。原发灶不同病理类型的脑转移瘤单发及多发病灶分布情况的差异有统计学意义（P＜005）。 结论肺癌确诊患者2年内脑转移高发,其中1年内发生其他脏器转移者的脑转移风险更高。肺癌脑转移瘤常多发,转移灶多位于幕上。     

肺癌脑转移的MRI特点

目的 讨肺癌脑转移的MRI特征及其与病理类型的关系。方法 858例经临床及病理证实为肺癌的患者行脑部MRI检查,并进行回顾性分析与其原发肿瘤的病理类型进行对照研究。结果 58例行MRI检查的患者中,有脑转移者393例,占45．8％。其中腺癌117例(29．8％),小细胞肺癌110例(28．0％),鳞癌52例(13．2％),腺鳞癌16例(4．1％),大细胞癌2例(0．5％),类癌1(0．3％),不知确切病理亚型95例(24．2％)。在19例脑膜转移的患者中,原发病为腺癌6例,小细胞肺癌5例,鳞癌4例,病理类型不明者4例。在374例脑实质转移的患者中,病灶周围无明确水肿120例,轻度水肿98例,中度水肿70例,重度水肿86例。结论 癌容易发生脑转移,MRl增强扫描有助于肺癌脑转移的诊断。     

Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy. Report by the Radiation Therapy Oncology Group

This report details the patterns of tumor recurrence in two prospective randomized studies involving 551 patients with histologically proven unresectable or medically inoperable non-oat cell carcinoma of the lung treated with definitive radiotherapy. Patients were treated according to two protocols, depending on the stage of the tumor: (1) Patients with T1, 2, 3-NO, 1, 2 tumors were randomized to four different regimens: 4000 cGy split course (2000 cGy in five fractions, per 1 week, 2 weeks rest and additional 2000 cGy in five fractions, per 1 week) or 4000, 5000, or 6000 cGy continuous courses, five fractions per week. (2) Patients with T4, any N or N3, any T stage tumors were randomized to be treated with 3000 cGy tumor dose (TD), ten fractions in 2 weeks, 4000 cGy split course (described above), or 4000 cGy continuous course. In the patients with less advanced tumors (Study 1) the intrathoracic failure rate within the irradiated volume was 48% with 4000 cGy continuous, 38% with 4000 cGy split course or 5000 cGy continuous, and 27% for patients receiving 6000 cGy continuous course. The failure rate in the nonirradiated lung ranged from 25% to 30% in the various groups. Patients with adenocarcinoma or large cell undifferentiated carcinoma had better intrathoracic tumor control (35%) than those with squamous cell carcinoma (20%). The incidence of distant metastases was 75% to 80% in all histologic groups. Distant metastases appeared sooner after therapy in the patients with adenocarcinoma or large cell undifferentiated carcinoma. The initial failure rate in the brain was 7% in patients with squamous cell carcinoma, 19% with adenocarcinoma, and 13% in patients with large cell carcinoma. The ultimate incidence of brain metastases was 16% in squamous cell carcinoma, and 30% for adenocarcinoma or large cell undifferentiated carcinoma. Higher doses of irradiation will be necessary in order to improve the intrathoracic tumor control. Clinical trials by the Radiation Therapy Oncology Group, some of them involving multiple daily fractionation, are in progress. Furthermore, because of the high incidence of distant metastases, effective systemic cytotoxic agents are critically needed to improve survival of lung cancer patients. The high frequency of brain metastases suggests that, as in small cell carcinoma of the lung, elective irradiation of the brain may be necessary, if not to improve survival to enhance the quality of life of patients with adenocarcinoma and large cell carcinoma.     

87例非小细胞肺癌脑转移三维适形放疗疗效分析

目的:探讨非小细胞肺癌脑转移三维适形放疗联合全脑照射的疗效及预后因素。方法:回顾性分析1997年12月至2003年12月在本院行三维适形放疗的87例非小细胞肺癌脑转移患者的临床资料,所有病例先行全脑照射,然后缩野至局部病灶行三维适形低分割推量照射。用Kaplan-meier法分析局部控制率及生存率,预后多因素分析用COX比例风险模型。结果:中位生存时间为14个月,12个月、24个月生存率分别为53%、20%;6个月、12个月局部控制率分别为99%、93%。多因素分析提示颅脑外活动性病灶(P=0.006)、脑转移灶数量(P=0.035)、转移间隔时间(P=0.040)是独立的生存预后因素。结论:三维适形放疗联合全脑照射可有效控制非小细胞肺癌脑转移灶,不良反应可耐受。     

Risk of cerebral metastases and neurological death after pathological complete response to neoadjuvant therapy for locally advanced nonsmall-cell lung cancer: clinical implications for the subsequent management of the brain

BACKGROUND: The incidence and pattern of brain metastases was analyzed among patients who achieved a pathological complete response (pCR) after neoadjuvant chemotherapy or chemoradiotherapy for locally advanced nonsmall-cell lung cancer (NSCLC). METHODS: Between 1990 and 2004, 211 patients were treated with neoadjuvant therapy before surgical resection for stage III NSCLC. The clinical course of 51 patients who demonstrated a pCR were reviewed. The neoadjuvant regimen consisted of either chemotherapy (29 patients) or chemoradiotherapy (22 patients). Histology was 45% adenocarcinoma, 41% squamous cell, and 14% large cell carcinoma. No patient received prophylactic cranial irradiation (PCI). RESULTS: Overall survival at 1, 3, and 5 years was 82%, 63%, and 42%, respectively. The most common site of initial recurrence was the brain. Twenty-two (43%) patients developed brain metastasis as the site of first failure, which represented 71% of all isolated recurrences. Ultimately, 28 (55%) patients developed brain metastases at some point during their clinical course. The 5-year estimates of brain metastasis-free survival for patients with squamous and nonsquamous cancers were 57% and 34%, respectively (P = .02). Median survival from the time of brain metastasis was 10 and 5 months for those with isolated and nonisolated recurrences, respectively. CONCLUSION: Patients with a pCR after multimodality therapy for locally advanced NSCLC are at excessively high risk for the subsequent development of brain metastases. Implications for management strategies including PCI and stereotactic radiosurgery (SRS) are discussed.     

Radical radiation therapy of advanced lung cancer: evaluation of prognostic factors and results of continuous and split course treatment.

One hundred patients with inoperable (80) or unresectable (20) bronchogenic carcinoma without evidence of spread beyond the thorax and supraclavicular nodes were planned for radical radiotherapy. Seventy-six patients received continuous irradiation (6000 rads in 30 treatments in 6 weeks, TDF 99) and 24 received split course therapy (2 courses of 2500 rads in 10 treatments with a 3 week break between courses, TDF 88). Forty-three patients had squamous cell carcinoma or adenocarcinoma and were considered to have favorable prognostic factors, while 57 patients had unfavorable prognostic factors: undifferentiated large cell or small cell carcinoma, supraclavicular metastases, SVC obstruction, superior sulcus tumors, or bone erosion in continuity with the tumor. Ninety-two patients completed the planned course of treatment. In patients completing treatment, local control of cancer within the irradiated volume was achieved in 58.5% of continuously irradiated patients and 45.4% of patients receiving split course therapy. Median survival was 1.2 months in patients not completing treatment and 12 months for the patients who completed treatment; 19% of the total group survived 3 years. Median and 3 year survivals of 14 months and 20.4% and of 9 months and 11% were observed for patients treated continuously and by the split course techniques, respectively. Corresponding survival figures for patients with favorable and unfavorable prognostic signs were 21 months and 26%, and 4 months and 11%, respectively. Implications of these data for treatment planning and patient selection for radical radiotherapy in bronchogenic carcinoma are discussed.     

Ⅳ期非小细胞肺癌287例放疗后的生存分析

背景与目的:很多Ⅳ期非小细胞肺癌(non-smallcelllungcancer,NSCLC)的患者需要放疗,特别是对脑、骨转移者放疗有很好的治疗作用。本研究旨在分析放疗对Ⅳ期NSCLC患者生存的影响。方法:对287例资料完整的Ⅳ期NSCLC放疗患者进行回顾性分析。脑放疗为平行对穿两野全脑照射,骨放疗为单野局部照射,对原发灶、区域淋巴结和其它转移部位用2维常规分割或3维适形放疗(3dimensionalconformalradiotherapy,3D-CRT)。脑和骨放疗通常采用4周20次共40Gy或2周10次共30Gy的治疗方案,原发灶和区域淋巴结的中位照射剂量是50Gy(20～70Gy),其它转移部位的中位照射剂量是46Gy(40～60Gy)。结果:全部患者中位生存期9个月(8～10个月),1年和2年生存率分别是30.2%和8.9%。有化疗和无化疗者中位生存期分别为10个月和8个月(P=0.049)。有脑转移、骨转移、其它转移者中位生存期分别为8个月、9个月、10个月,1年生存率分别24.8%、28.7%和37.5%,2年生存率分别为6.7%、7.0%和15.3%。单因素分析发现对生存有显著影响的因素为病理类型和年龄。腺癌患者的生存期高于鳞癌和其它病理类型,中位生存期分别为10个月、7个月、9个月(P=0.046);≤60岁的患者生存期显著高于>60岁的患者,中位生存期分别为11月、8个月(P=0.012);单纯骨转移患者的中位生存期要大于合并有其它转移者(10个月与6个月,P=0.033),而单纯脑转移和同时合并有其它转移的两组患者中位生存期却无明显差异(9个月与8个月,P=0.3742);肿瘤原发灶和区域淋巴结是否放疗对患者生存时间影响不大(10个月与8个月,P=0.066);是否伴有其它慢性疾病对患者的生存期无明显影响(9个月与10个月,P=0.306)。对脑和骨转移的患者采用4周20次40Gy或2周10次30Gy放疗对生存期无明显影响。结论:病理类型、年龄对Ⅳ期NSCLC患者的放疗疗效有显著影响,全脑和骨转移采用4周20次40Gy或2周10次30Gy放疗对生存期无明显影响。     

Is adenocarcinoma/large cell carcinoma the most radiocurable type of cancer of the lung?

Radiation therapy is widely considered the primary treatment for inoperable "non-small" cell carcinoma of the lung. In clinical investigations, distinction has been infrequent among the histopathologic subtypes of non-small cell carcinoma. Studies have shown significant differences between squamous cell carcinoma and adenocarcinoma/large cell carcinoma; adenocarcinoma/large cell carcinoma has a greater propensity for extrathoracic dissemination, especially to the brain, and it is less curable by resection when regional lymph node metastases are present. No differences have been documented between adenocarcinoma and large cell carcinoma. A retrospective study was undertaken to determine the results of definitive radiation therapy by histopathologic subtype of non-small cell carcinoma of the lung. Between July 1977 and April 1983, 134 patients with non-small cell carcinoma of the lung underwent definitive radiation therapy with curative intent. All patients had performance status scores of 80 to 100 (Karnofsky), and received minimum total doses within the tumor of 60 Gy in 6 to 7 weeks, five fractions per week. The median period of observation was 63 months. Ninety patients had squamous cell carcinoma; 44 had adenocarcinoma/large cell carcinoma. The two groups of patients were comparable in respect to age and Stage; there were significantly more women with adenocarcinoma/large cell carcinoma (27%) than with squamous cell carcinoma (13%). The median survival for patients with squamous cell carcinoma was 11.5 months; the 2 and 4 year survival rates were 21 and 7%, respectively. The median survival for patients with adenocarcinoma/large cell carcinoma was 18 months; 2 and 4 year survival rates were 38 and 23%, respectively. Comparison of the overall survival experience did not show a significant difference between the two cell types (p = .12 using Gehan's generalized Wilcoxon test). However, comparison of the proportion of patients with adenocarcinoma/large cell carcinoma surviving 18 months (50%) was significantly higher (p = .02) than that with squamous cell carcinoma (30%). A small body of data from the literature also suggests a better long-term prognosis for adenocarcinoma/large cell carcinoma. This observation requires confirmation from large trials with histopathologic review. If it is confirmed, there are important implications for therapeutic strategies in future clinical investigations of inoperable carcinoma of the lung.     

Multivariate analysis of factors predictive of brain metastases in localised non-small cell lung carcinoma

Brain metastases are a frequent feature of the course of non-small cell lung carcinoma (NSCLC). The potential usefulness of prophylactic cranial irradiation (PCI) has led to the search for target groups likely to derive benefit. This multivariate analysis looked for factors predictive of brain metastases in a group of stages I-III NSCLC patients under care of the thoracic oncology unit of Besan?on University Hospital from 1977 to 2001. All the patients had the same follow-up. They were divided into two groups: BM+ when they had a brain metastasis as the first site of progression, whether solitary or not, and BM(-) otherwise. Variables analysed were age, gender, performance status (0-1 versus 2-3), weight-loss stage T-status, N-status, pathological type, type of treatment, administration of chemotherapy, use of cisplatin and response to treatment. Three hundred and five patients were eligible and there were 77 patients (25.25%) in the BM+ group. Median time to onset of brain metastases was 12 months (1-163 months) and median survival from the diagnosis of brain metastases was 6 months (1-65 months). Factors predictive of brain progression were age < or =62 years (RR: 2.5, 95% CI: 1.33-4.76 and P = 0.004), T4 tumour status (RR: 3.75, 95% CI: 1.72-8.21 and P = 0.0009), N2-3 (RR: 2.61, 95% CI: 1.32-5.15 and P = 0.0057), and adenocarcinoma (RR: 3.39, 95% CI: 1.78-6.46 and P = 0.0002). No aspect of treatment plays a role in the frequency of this type of metastasis. These factors predictive of brain progression could serve as a basis for the selection of patients with the aim of sitting of studies on prophylactic cranial irradiation in NSCLC.     

BRAIN METASTASES FROM CARCINOMA OF UTERINE CERVIX

Metastatic spread of cervical carcinoma occurs by local extension and lymphatic dissemination, yet distant metastases do occur in advanced stage. The common sites of distant metastases include liver, lung, and bone. However, brain metastases are uncommon. We had 11 patients with brain metastases from cervical carcinoma in recent decade and retrospectively reviewed these cases to study the mechanisms, diagnosis, treatment, and prognosis. MATERIALS AND METHODS Between January 1990 and…     

肺癌脑转移38例临床病理分析

 本文报告了38例肺癌脑转移病例，男28例、女10例，年龄27～75岁，平均55岁。中心型肺癌25例、周围型11例、弥漫型2例。鳞状细胞癌10例、腺癌18例、小细胞癌7例、大细胞癌3例。肺腺癌最易发生脑转移18/38（47．4%）。小细胞肺癌脑转移早于其他类型。以脑转移瘤为首发症状者易误诊。适当应用手术，放疗及化疗等方法，可在一定程度上改善病人症状，延长病人生存时间。     

食管鳞癌脑转移患者的临床特征和影响因素及其对生存的影响

目的 探讨食管鳞癌脑转移患者的临床特征、影响因素及其对生存的影响。方法 回顾性分析2000年12月—2015年12月我院收治的食管鳞癌脑转移67例患者的临床病理资料,分析食管癌脑转移与临床病理特征及生存率的相关性。结果 食管鳞癌脑转移瘤个数与T分期、N分期呈正相关（P<0.05）。全组患者中位生存期为9.65月;Logistic回归分析显示N2、N3分期是食管鳞癌患者发生脑转移的危险因素,N0、N1期患者出现脑转移的风险更低（P<0.05）。Log rank生存分析显示,脑转移瘤个数为1的食管鳞癌患者的预后优于脑转移瘤个数为2和3的患者（P<0.05）;N0+N1期患者预后好于N2和N3期的患者（P<0.05）;多因素Cox回归模型显示,T3+T4、N3、是否做全脑放疗是影响食管鳞癌脑转移患者的预后独立影响因素（P<0.05）。结论 食管鳞癌脑转移瘤数量与T、N分期呈正相关。N分期越晚,脑转移风险越大。T、N分期越晚,食管鳞癌脑转移患者预后越差。全脑放疗可以获得更大的生存获益。     

不可手术的局部晚期非小细胞肺癌患者胸部放疗后脑转移特征及危险因素分析

目的 探讨不可手术的局部晚期非小细胞肺癌患者胸部放疗后脑转移特征及其危险因素.方法 选取经组织病理学检查或免疫组化检查证实的不可手术的局部晚期非小细胞肺癌患者72例.根据患者各项资料,分析不可手术的局部晚期非小细胞肺癌患者放疗后脑转移特征,使用多因素Logistic回归分析影响不可手术的局部晚期非小细胞肺癌患者放疗后脑转移的危险因素.结果 72例患者中,15例(20.83%)患者出现脑转移,其中腺癌14例,鳞癌1例;单纯脑转移2例,脑转移合并其他部位转移13例.患者出现脑转移的中位时间为8.5个月,1年、3年累积脑转移率分别为16.31%、29.94%.单因素分析结果显示:患者的年龄、吸烟史、CA125、NSE、CEA与局部晚期非小细胞肺癌患者胸部放疗后脑转移存在一定关系(P﹤0.05).多因素Logistic回归分析结果显示:年龄﹥60岁、有吸烟史、CA125升高、NSE升高、非鳞状细胞癌是影响局部晚期非小细胞肺癌患者胸部放疗后脑转移的危险因素.结论 年龄﹥60岁、有吸烟史、CA125升高、NSE升高、非鳞状细胞癌的局部晚期非小细胞肺癌患者胸部放疗后出现脑转移的危险性高.     

肺鳞癌与腺癌非手术治疗预后差异的原因分析

目的分析非手术治疗的肺鳞癌与腺癌预后差异的原因。方法１９９０年１２月～１９９４年１２月间以根治性放疗为主的非手术治疗１７７例肺癌（鳞癌１２５例，腺癌５２例），采用Ｋａｐｌａｎ－Ｍｅｔｅｒ计算方法和Ｃｏｘ多因素分析方法分析鳞癌和腺癌的生存率、肿瘤局部控制率、无远处转移率，并进行比较。结果１年和２年生存率，肺鳞癌为８０．３％和４４％，显著高于腺癌的５５．４％和１７．２％（Ｐ＜０．００１）；１年和２年局部控制率，肺鳞癌为７９．５％和４３．４％，肺腺癌为５４．３％和２７．６％（Ｐ＝０．００７）；１年和２年无远处转移率，肺鳞癌为８６％和７３．９％，腺癌为６２．８％和２２．９％（Ｐ＜０．００１）。Ｃｏｘ多因素分析结果表明组织学类型在生存率、局部控制率、无远处转移率三项指标中均有显著差异（产均＜０．０１）。结论在非手术治疗中，肺鳞癌较腺癌患者预后好；预后差异的原因在于鳞癌局部控制率高而远处转移率低。     

Radiosurgery for solitary brain metastases using the cobalt-60 gamma unit: methods and results in 24 patients.

To define the role of stereotactic radiosurgery in the treatment of metastatic brain tumors we treated 24 consecutive patients (20 men, 4 women) with the 201-source 60Co gamma unit between May 1988 and March 1990. The primary tumors included malignant melanoma (n = 10), non-small cell lung carcinoma (n = 6), renal cell carcinoma (n = 3), colorectal carcinoma (n = 1), oropharyngeal carcinoma (n = 1), and adenocarcinoma of unknown origin (n = 3). All tumors were less than or equal to 3.0 cm in greatest diameter. Twenty patients received a planned combination of 30-40 Gy whole brain fractionated irradiation and a radiosurgical "boost" of 16-20 Gy to the tumor margins; one patient refused conventional fractionated irradiation. Three patients with recurrent, persistent, or new non-small cell lung carcinomas had radiosurgical treatment 12-20 months after receiving 30-42.5 Gy whole-brain external beam irradiation. Stereotactic computed tomographic imaging was used for target coordinate determination and imaging-integrated dose planning. All tumors were enclosed by the 50-90% isodose shell using one (n = 22), two (n = 1), or three (n = 1) irradiation isocenters. During this 23-month period (median follow-up of 7 months) no patient died from progression of a radiosurgically-treated brain metastasis. Ten patients died of systemic disease (n = 8) or remote central nervous system metastasis (n = 2) between 1 week and 10 months after radiosurgery. One patient had tumor progression and underwent craniotomy and tumor excision 5 months after radiosurgery. To date, median survival after radiosurgery has been 10 months; 1-year survival was 33.3%. Stereotactic radiosurgery eliminated the surgical and anesthetic risks associated with craniotomy and resection of solitary brain metastases. Radiosurgery also effectively controlled the growth of tumors considered "resistant" to conventional irradiation.     

Gamma knife radiosurgery for management of cerebral metastases from esophageal carcinoma

Esophageal carcinoma rarely results in intracranial metastases but when it does, the patient prognosis is grim. Because of its rarity outcomes after stereotactic radiosurgery (SRS) are not known. We sought to evaluate the outcomes of SRS in the management of esophageal cancer that has spread to the brain. This single institution retrospective analysis reviewed our experience with esophageal metastasis from 1987 to 2013. Thirty patients (36 SRS procedures) with a median age of 59 (37–86 years) underwent Gamma knife^® SRS. The esophageal origin was adenocarcinoma in 26 patients (87 %), squamous cell carcinoma in 3 patients (10 %), and mixed neuroendocrine carcinoma in 1 patient (3 %). Fifteen patients were treated for a single metastasis and 15 patients were treated for multiple metastases for a total of 87 tumors. The median tumor volume was 5.7 cm³ (0.5–44 cm³) with a median marginal dose of 17 Gy (12–20 Gy). The median survival time from the diagnosis of brain metastasis was 8 months and the median survival from SRS was 4.2 months. This corresponded to a 6-month survival of 45 % and a 12-month survival of 19 % after SRS. A higher KPS at the time of procedure was associated with an increase in survival (p = 0.023). The local tumor control rate in this group was 92 %. Four patients had repeat SRS for new metastatic deposits. One patient developed a new neurological deficit after SRS. SRS proved an effective means of providing local control for esophageal metastases to the brain. Concomitant systemic disease progression at the time of brain metastasis resulted in poor long-term survival.     

立体定向伽玛刀放射外科治疗肺癌脑转移瘤的疗效分析

目的:探讨伽玛刀治疗肺癌脑转移瘤的临床疗效及不良反应。方法:选择伽玛刀治疗肺癌脑转移瘤患者236 例,根据病变大小和部位选用4-18mm 准直器靶点,肿瘤边缘剂量12-22Gy,平均17Gy,中心剂量32-40Gy,平均35.4Gy,边缘等剂量曲线40%-75％,平均58％。 结果:对全部患者伽玛刀治疗后进行临床随访,视具体情况1-3 个月复查影像,随访时限不少于半年;6个月、12个月患者生存率,腺癌患者分别为69.1％（56/81）、38.3％（31/81）,鳞癌患者为60.0％（45/75）、20.0％（15/75）,小细胞癌患者则为62.7％（37/59）、27.1％（16/59）;伽玛刀治疗后1-3个月随访KPS评分,提高128 例（54.2％）,不变81 例（34.3％）,下降27例（11.4％）。腺癌、鳞癌、小细胞癌、鳞腺混合癌脑转移瘤局部控制有效率分别为87.7％（71/81）、93.3％（70/75）、100％（59/59）、85.7％（18/21）。无1例患者出现严重脑水肿而终止放疗,无1例患者出现严重骨髓功能抑制。 结论:伽玛刀治疗肺癌脑转移瘤具有疗效好、安全的优势,能有效提高脑转移瘤患者生活质量,延长生存期。     

135例食管鳞癌肺转移预后因素分析

目的:探讨食管鳞癌肺转移患者预后的影响因素。方法:回顾性分析2008—2018年间浙江省肿瘤医院135例食管鳞癌治疗后肺转移患者的临床特点。运用 Kaplan- Meier法计算生存率, log- rank法单因素预后分析, Cox模型多因素预后分析。 ...